/ HS405 Dangerous Goods Manifest
for {insert building name}
Document Number / Initial Issue Date: / Current Version Number: / Current Version Date: / Next review Date:
Annual review required

1. General Information

Schools/Units:

·  {list relevant schools within this building which are included}

Address:

·  {insert – including nearest gate entrance}

Date this manifest was Prepared: (annual review required)

· 

2. Emergency Contacts

Name / Position / School / Centre / Office Location
(room number) / Telephone
(incl. mobile)
Include positions such as:
· Chief and deputy chief wardens
· Heads of schools/centres
· Lab managers
· Academics in charge

3.  Summary of Dangerous Goods Classes

{From the information in tables 4.1 and 4.2 add up all quantities for each DG class to provide the total quantity of each class for the building}

Dangerous Goods Class / Packing Group / Maximum Quantity STORED (i.e. total) /
2.1 Flammable Gas / n/a
2.2 Non-Flammable Gas / n/a
2.2 Non-Flammable Gas: Oxygen / n/a
2.2 Liquefied Cryogens / n/a
2.3 Toxic Gas / n/a
3 Flammable Liquids / I,II and III
4 Flammable Solids / I,II and III
5 Oxidising Agents and Organic Peroxides / I,II and III
6 Toxic Substances / I,II and III
8 Corrosive Substances / I,II and III

4.  Specific Dangerous Goods Details

4.1.  Bulk Supplies of Dangerous Goods {e.g. cryogen tanks}

Identification of Tank (e.g. assets number etc.) / Dangerous Goods / Maximum
Quantities / Contact
Class / UN Number
Proper Shipping Name / Class / PG
(I, II, III) / HazChem
Code / Typical
Qty / Unit
e.g. L/Kg

4.2.  Other Package Storage Areas:

e.g. Gas cylinder storage areas and Dangerous Goods Storage Cabinets (i.e. Flammable /Toxic/ Corrosive / Oxidising Cabinets etc.}

Also make note of any Packing Group I substances or Toxic gases to complete tables 4.3 and 4.4

Floor / Room Number / DG
Class / Sub Risks
{if applicable} / Packing Grp.
{if applicable} / Maximum Quantity L/Kg
{e.g. 250L cabinet} / Contact /

4.3.  List of any Toxic Gas Cylinders and their location

{If there is any Toxic Gas stored in any of the storage locations in table 4.1 list it here}

Dangerous Goods Class 2.3 TOXIC GASES
Location
{i.e. floor and room number} / DG Class / chemical name / Cylinder Size / No. Cylinders / Total Qty
2.3
2.3
2.3
2.3
2.3
2.3
Total / Kg

4.4.  List of packing group 1 chemicals and their location

{If there are packing group I substances stored in any of the storage locations in table 4.1 list them in the corresponding table below}

Dangerous Goods Class 3: Flammable Liquids
Location
{i.e. floor and room number} / DG Class / chemical name / Pack Size / No. Packs / Total Qty
3
3
3
3
3
3
Total / L
Dangerous Goods Class 4: Flammable Solids
{including Spontaneously combustible or water sensitive chemicals}
Location
{i.e. floor and room number} / DG Class / chemical name / Pack Size / No. Packs / Total Qty
4
4
4
4
4
Total / Kg
Dangerous Goods Class 5 - OXIDISING LIQUIDS
{including self reactive substances or organic peroxides}
Location
{i.e. floor and room number} / DG Class / chemical name / Pack Size / No. Packs / Total Qty
5
5
5
5
5
5
Total / L
Dangerous Goods Class 5 -OXIDISING SOLIDS
{including self reactive substances or organic peroxides}
Location
{i.e. floor and room number} / DG Class / chemical name / Pack Size / No. Packs / Total Qty
5
5
5
5
5
5
Total / Kg
Dangerous Goods Class 6: Toxic LIQUIDS
Location
{i.e. floor and room number} / DG Class / chemical name / Pack Size / No. Packs / Total Qty
6
6
6
6
6
6
6
6
Total / L
Dangerous Goods Class 6: Toxic SOLIDS
Location
{i.e. floor and room number} / DG Class / chemical name / Pack Size / No. Packs / Total Qty
6
6
6
6
6
6
6
Total / Kg
Dangerous Goods Class 8: Corrosive LIQUIDS
Location
{i.e. floor and room number} / DG Class / chemical name / Pack Size / No. Packs / Total Qty
8
8
8
8
8
8
8
8
Total / L
Dangerous Goods Class 8: Corrosive SOLIDS
Location
{i.e. floor and room number} / DG Class / chemical name / Pack Size / No. Packs / Total Qty
8
8
8
8
8
8
Total / Kg

HS405 Template for Dangerous Goods Manifest

V1.1: 26/02/2016